Short guideline for endometriosis
I have endometriosis
Without a laparoscopy
- the diagnosis is only a suspicion of superficial endometriosis, except when a cystic ovarian endometriosis was diagnosed by ultrasound
- If pain started acutely endometriosis is unlikely. A cystic corpus luteum needs to be excluded.
- If a BIG deep endometriosis nodule is diagnosed by clinical exam or ultrasound (MRI), the diagnosis is probably correct ; for smaller lesions the risk of false positives and of false negatives is high
- I you do not know the type of endometriosis your gynecologist is probably is not a real specialist
If a laparoscopy is planned, you need to check
- A cystic ovarian endometriosis of more than 6 cm needs surgery in 2 steps otherwise the ovary risks to be destroyed.
- If a large deep endometriosis is suspected, hydronefrosis (e.g. with ultrasound) and bowel stenosis (with a contrast enema) need to be excluded before surgery
- An ureter stent is indicated only in cases of hydronefrosis
- Check the level of expertise of the surgeon and the percentage of bowel resections performed. A bowel resection is rarely needed (<10%) and should be decided during surgery. Too often avoidable bowel resections are performed.
Surgery was not performed during the laparoscopy
- The diagnosis is probably correct
- Check the photo’s or video to ascertain that all has been checked such as appendix, the sigmoid and diaphragm
- This is correct; if lesions were unexpectedly severe it is better not to do surgery without the required expertise.
If surgery was performed, you should know at least.
- the type of intervention and the type of endometriosis
- complete or incomplete excision ?
- complications ?
- duration of surgery ?
- video or at least photo-documentation ?
Medical treatment was started without a laparoscopy, thus without a diagnosis
- this can be done occasionally on the waiting list, not as a preparation for surgery
- this can be given for a short period to evaluate the effect on pain
- for a longer period without a diagnosis is a mistake